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Welcome to the
2009 Dallas Sun!
Enhancing Realism
Gail Rea, RN, PhD, CNE
Beth Haas, MPH, CHES
Be an Imagineer!!
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Leader in their Field….. Why??
Imagination is only limited by________!!!!!!
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When you are struggling with writing simulation, remember:
– “ I have not failed, I’ve just found 10,000 ways that don’t work” –
Thomas Edison
What is Realistic?
• Reality = a matter of perception
• As long as participants perceive the environment and
responses as plausible, then the simulation will remain intact
Factors that are Required for a
Successful Realistic Simulation
• Plausible Environment
• Plausible Responses
• Plausible Interactions
• Familiar Equipment
• Realistic Simulation Equipment
–
Seropian, M. Technology, Computing and Simulation (2003) Anesth Analg
Fidelity
• the quality or state of being faithful b: accuracy in details :
exactness 2: the degree to which an electronic device (as a
record player, radio, or television) accurately reproduces its
effect (as sound or picture)
Types of Fidelity
• Low Fidelity
Types of Fidelity
• High Fidelity
Equipment Fidelity
• The degree to which the simulator duplicates the appearance
and feel of the real system.
Environmental Fidelity
• The extent to which the simulator duplicates motion cues,
visual cues, and other sensory information from the task
environment.
Environmental Fidelity
Psychological Fidelity
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Degree to which the trainee perceives the simulation to be a believable surrogate for
the trained task or real patient encounter
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Allows learner to make conceptual sense of the scenario
A Typology of simulation fidelity (adapted from Rehmann et al, 1995)
Beaubien, Baker. Quality and Safety in Health Care, 2004.
Fiction Contract
• Is a joint endeavor that students and the de-briefer create
– The instructor agrees to make the simulation as real as
possible within the resource and technology constraints
– Participants agree to do their best to act as if everything is
real. (Suspend Disbelief)
“A successful scenario is not based on the realism of
the simulation itself, but rather the alchemy of
participants stepping into their roles, connecting with
others in the scenario, and actively linking to their
previous social, clinical, and psychological experience.”
Rudolph et al. Sim Healthcare. 2(3):161-163, Fall 2007.
Moulage
Moulage
Moulage
Nursing Modules
Nursing wounds can be added to the
simulator for realism in wound
assessment and care scenarios.
Modules in kit:
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Chest surgical incision with skin staples (lay on)
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Abdominal packing and irrigation wound (lay on)
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Abdominal surgical incision lay-ons, featuring:
– Nylon sutures and penrose drain
– Staples and penrose drain
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Infected colostomy stoma
Lacerated hand
Forearm suture module
Gluteal and vetro-gluteal pressure ulcer modules
Thigh packing and irrigation wound
Thigh suture module
Thigh debridement module
Below knee amputation
Varicose vein leg with stasis ulcer
Bleeding Control Modules
Designed to teach the rapid identification and effective management
of bleeding control to prevent loss of life.
Bleeding wounds featured:
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Traumatic Amputation Arm
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Traumatic Amputation Thigh
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Gunshot Wound Arm (not pictured)
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Gunshot Wound Thigh
Includes: Appendages
Reservoirs with tubing (4)
Simulated blood (4)
Carry case
Extra additions:
Forced air bleeding control system
Trauma Modules
Interchangeable trauma modules are for added realism in emergency
trauma management.
Modules in kit:
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Projectile wounds – small and large calibre entry and exit wound
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Crushed foot – ® foot with exposed bone and soft tissue
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1st,2nd and 3rd degree burns – sleeve for ® arm
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Closed fracture – ® leg tibia and fibula
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Exposed viscera – abdominal lay-on
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Amputation – small toe of ® foot
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Impaled object – thigh
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Open fracture – femur
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Contused ankle and foot
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Trauma face overlay
Nuclear, Biological &
Chemical Kit
Important for clinicians, first
responders, military personnel
and educators to be able to
recognise, diagnose, and treat
the symptoms of nuclear,
biological and chemical
attacks.
Offers the ability to replicate
the effects of toxic agents by
producing realistic, frothy,
body fluids that emanate from the
tear ducts, mouth and nose.
How to protect your simulator skin
Let Dry!!
Use sponge to apply blue/purple
eye-shadow/stage make-up
Blend together with sponge
Seat Belt Bruising
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Use sponge to apply bruising in a pattern to represent an apparent
bruise from a seatbelt.
Gun Shot Wound
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Apply schkin/liquid latex
Make a divot in the skin to
represent a bullet hole
Optional: Place eraser head in
wound to mimic bullet
Apply ash around area if GSW
was at close range
Use pourable stage blood out of
GSW Wound
Impalement
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Build up Schkin/liquid latex and
mold into area
Apply color wheel
Insert impalement into schkin
Apply stage blood as
appropriate
Cleaning Supplies
Lacerations
• Schkin
– Petroleum jelly,
cocoa, cornstarch
– Red lipstick
– Coagulated blood
– Medium blood
– Thin blood on site
• Liquid Latex
– Can be purchased at
a theater store
• 3D Gel
– Can be purchased at
a theater store
Impalements
• Same as lacerations
• Impale object
– Plastic shard
– Medium blood
Compound Fractures
• Same as lacerations
• Impale bone
– Chicken
– Rib
• Cotton
• Red lipstick
• Rubber bands
• Coffee stirrers
Stabbing
MOULAGE
Examples of Burns/Blisters
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Apply Liquid Latex/3D Gel/Schkin
Fill syringe with petroleum jelly, squirt “blisters” into base.
“Bruise” with powder
Dust with fireplace ash (optional)
Fiber Therapy With Warm Water
Pour on quickly! It is like applesauce and then sets up!
Smooth Out
Using water, we smooth to about 1/8” thickness.
Let It Dry
When none stays on the fingertips (test), it is ready for the next step.
Making “Blisters”
We place the tip of a syringe filled with petroleum jelly under the
fiber therapy and push…
Blisters
… making simulated blisters.
Blisters
Then we tap on medium “blood”…
Blisters
Blisters
Examples of Burns/Blisters
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Option 2:
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Apply liquid latex to an area
where you would like a
burn/blister to appear.
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Let Air Dry to a dry/tacky
consistency
Designing of Burn
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Once to a dry/slightly tacky
consistency, use cue tip to pull
areas of the liquid latex apart
to make appearance of
burn/sliding skin.
Apply blood, shadow, and ash/charcoal to
wound, cover with petroleum Jelly
Example of Burn/Blister
Resources
•http://www.laerdal.com/usa/SUN/ppt/Chez_
Moulage.pdf
•http://www.cert-la.com/education/moulagerecipes.pdf
•http://moulageconcepts.com/about.html
•Ben Nye Moulage Kit
•Visit your local theater supply/Halloween
store
Your Challenge